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HomeMy WebLinkAboutOTC15-0026NOTE: THIS PERMIT MUST BE POSTED ON JOBSITE AT ALL TIMES AWN 0� YAIl.' . Town of Vail, Community Development, 75 South Frontage Road, Vail, Colorado 81657 p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149 OVER THE COUNTER PERMIT OVER THE COUNTER Permit #: OTC15 -0026 Job Address: 366 FOREST RD VAIL Location......: Parcel No....: 210107114010 Valuation.....: $60,000.00 OWNER BLUMBERG, MARVIN R. & DIANE 06/03/2015 2305 VALLEY AVE WILMINGTON, DE 19810 Project #: PRJ15 -0054 Applied.....: 06/03/2015 Issued...: 06/03/2015 CONTRACTOR MDJSS -SETH BLUMBERG 06/03/2015 Phone: 202 - 528 -9059 PMB 200 2121 N FRONTAGE RD W VAIL CO 81657 License: C000004088 APPLICANT PEEL /LANGENWALTER ARCHITECTS 06/03/2015 Phone: 970 - 476 -4506 P.O. BOX 1202 VAI L CO 81658 License: C000001401 Description: Re -roof this side of duplex to match other side with Owens Corning Woodcrest "Chestnut" DECLARATIONS I agree to comply with the information and plot plan, to comply with all Town ordinances and state laws, and to build this structure according to the town's zoning and subdivision codes, design review approved, International Building and Residential Codes and other ordinances of the Town applicable thereto. REQUESTS FOR INSPECTION SHALL BE MADE TWENTY -FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149 OR AT OUR OFFICE FROM 8:00 AM - 4:00 PM. combination permit_012811 FEE SUMMARY Building Permit ------ - - - - -> $713.75 Bldg Plan Check ----- - - - - -> $463.94 Use Tax Fee------------------ - - - - -> $1,000.00 Electrical Permit ---- - - - - -> $0.00 Elec Plan Check ------ - - - - -> $0.00 Mechanical Permit - - - - - -> $0.00 Mech Plan Check ---- - - - - -> $0.00 Additional Fees--------------- - - - - -> ($5.00) Plumbing Permit --- - - - - -> $0.00 Plmb Plan Check ---- - - - - -> $0.00 Investigation------------------ - - - - -> $0.00 Will Call ------------------------------ > $5.00 TOTAL PERMIT FEES--------- - - - - -> $2,177.69 Payments ------------------------------- > $2,177.69 BALANCE DUE ------------------------ > $0.00 DECLARATIONS I agree to comply with the information and plot plan, to comply with all Town ordinances and state laws, and to build this structure according to the town's zoning and subdivision codes, design review approved, International Building and Residential Codes and other ordinances of the Town applicable thereto. REQUESTS FOR INSPECTION SHALL BE MADE TWENTY -FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149 OR AT OUR OFFICE FROM 8:00 AM - 4:00 PM. combination permit_012811 CONDITIONS OF APPROVAL TO BE MET PRIOR TO FINAL SIGN OFF Permit #: OTC15 -0026 Address: 366 FOREST RD VAIL Owner: BLUMBERG, MARVIN R. & DIANE Location: Cond: 8 (PLAN): No changes to these plans may be made without the written consent of Town of Vail staff and /or the appropriate review committee(s). Cond: 201 (PLAN): DRB approval shall not become valid for 20 days following the date of approval, pursuant to the Vail Town Code, Chapter 12 -3 -3: APPEALS. Cond: 202 (PLAN): Approval of this project shall lapse and become void one (1) year following the date of final approval, unless a building permit is issued and construction is commenced and is diligently pursued toward completion. combination permit-012811 OVATIL TOWN REQUIRED INSPECTIONS AND STATUSES Permit #: OTC15 -0026 Address: 366 FOREST RD VAIL Owner: BLUMBERG, MARVIN R. & DIANE Location: Item: 00542 PLAN -FINAL Item: 00090 BLDG -Final combination permit_012811 -KI OF VAI1 . caMgMpftr 71 D RE-F PERMT APPUCATION 'M hilsim iP�lt ier � Bpd bang ties e� a�m+riRw � D�� famd �wnal stswom NOW ► s taorgea t1 Cbitliat&r S Tp e.-`t SER V461e • C App"MV= TYPOf VdIdW Sdb~ o.gr*Ma.na • a w •„ rwno++caq NNOWME AMR# �y ftdr r ° af& • et�riia a�p�wda�si�ril�d 1q► • hiier,ta�pal�trs!�.a *Allmawebi prtk e pt tkn � F�dlwlew root p1�Glos t kN*; W*i hot ear awrhpl **"to iq �ifllbitiflh�nMll�nwquit�aNq #tr.pkl}�, owl* gut ft ilfAU�gq cmi+*vo,oM.le_tr , seidi ti .lo Qoiaphr r#rtdi t 4 A MW VM ****f. cl.af�. caret+ . Rind +ems 1,1114 will p�atRiAd1�► g77-A va OfUbgft dwft-doiP dR=4 aa+*Mow...ditft +r i wo el"s a�,e Ewa, M040* itt ,aDe d is aaow arer�oa, bod cst- aw Mktoiq&u A3 wW a4 'Vdvwm of OIIAW `(loo o �........ Yrluaafti�iKa�r#�iilg`pr�m k � � � Oq . - wwarr **� iwrrimam %am o DotRvMwva ; ts4ft It U TOWN OF VAIL The applicant must subspit written joint property owner approval for applications affecting shared ownership properties such as duplex, condominium, and multi- tenant buildings. This form, or similar written correspondence, must be com- pleted by the adjoining duplex unit owner or the authorized agent of the home owner's association in the case of a con- dominium or multi- tenant building. All completed forms must be submitted with the applicants completed application. I, (print name) ROV09tib 17. a joint owner, or authority of the association, of property located at J64 40,94 r7 -P.64A VRI!L . Lo y /&,rZ provide this letter as written approval of the plans dated which have been submitted to the Town of Vail Community Development Department for the proposed improvements to be completed at the address not- ed above. I understand that the proposed improvements include: ii R IMF i. ) ♦ a r i r. A L I understand that modifications may be made to the plans over the course of the review process to ensure compliance with the Town's applicable codes and regulations; and that it is the sole responsibility of the applicant to keep the joint property owner apprised of any changes and ensure that the changes are acceptable and appropriate. Submittal of an application results in the applicant agreeing to this statement. Signature Date Print Name FoU►I Cr-M AITYQeVELOP'ME.T Design Review Board Y ACTION FORM Department of Community Development 75 South Frontage Road, Vail, Colorado 81657 tel: 970.479.2139 fax: 970.479.2452 web: www.vailgov.com Project Name: Blumberg Re -roof DRB Number: DRB150040 Project Description: Re -roof this side of duplex to match other side with Owens Corning Woodcrest "Chestnut" Participants: OWNER BLUMBERG, MARVIN R. & DIANE 02/17/2015 2305 VALLEY AVE WILMINGTON, DE 19810 APPLICANT PEEL /LANGENWALTER ARCHITECTS 02/17/2015 Phone: 970 - 476 -4506 DAVE PEEL P.O. BOX 1202 VAIL CO 81658 License: C000001401 Project Address: 366 FOREST RD VAIL Location: Legal Description: Lot: 2 Block: 1 Subdivision: VAIL VILLAGE FILING 3 Parcel Number: 2101 - 071 - 1401 -0 Comments: Please see below. BOARD /STAFF ACTION Motion By: Action: STAFFAPP Second By: Vote: Date of Approval: 02/24/2015 Conditions: Cond: 8 (PLAN): No changes to these plans may be made without the written consent of Town of Vail staff and /or the appropriate review committee(s). Cond: 0 (PLAN): DRB approval does not constitute a permit for building. Please consult with Town of Vail Building personnel prior to construction activities. Cond: 201 (PLAN): DRB approval shall not become valid for 20 days following the date of approval, pursuant to the Vail Town Code, Chapter 12 -3 -3: APPEALS. Cond: 202 (PLAN): Approval of this project shall lapse and become void one (1) year following the date of final approval, unless a building permit is issued and construction is commenced and is diligently pursued toward completion. Planner: Jonathan Spence DRS Fee Paid: $20.00 ROCKY MOUNTAIN SNOW GUARDS INC, 2055 S. Raritan St. Denver, CO 80223 (877)414 -7606 Fax: (720)387 -8361 www.rockvmountainsnow,guards.com Snow Guard Layout Pattern Job Name: Seth Blumberg Location: Vail, CO Contractor: ? Roofing Material: Asphalt Shingles Slope: 6/12 -9/12 Ground Snow Load: 145 psf 2) Additional Rows C. Vertical Spacing 24" D. Horizontal Spacing 32" O/C Additional rows continue to peak. 1) Base 3 Row Eave Pattern: A. Horizontal Spacing 24" O/C B. Vertical Spacing 12" 1" Eave row is placed above exterior wall. Peak j ROCKY MOUNTAIN SNOW GUARDS INC, 2055 S. Raritan St. Denver, CO 80223 (877)414 -7606 Fax: (720)387 -8361 www.rockvmountainsnow,guards.com Snow Guard Layout Pattern Job Name: Seth Blumberg Location: Vail, CO Contractor: ? Roofing Material: Asphalt Shingles Slope: 6/12 -9/12 Ground Snow Load: 145 psf 2) Additional Rows C. Vertical Spacing 24" D. Horizontal Spacing 32" O/C Additional rows continue to peak. 1) Base 3 Row Eave Pattern: A. Horizontal Spacing 24" O/C B. Vertical Spacing 12" 1" Eave row is placed above exterior wall. Peak Eave Note: Roof support structure should always be reviewed to make sure that the additional snow held on the roof will not cause structural issues. ® M. Eave Note: Roof support structure should always be reviewed to make sure that the additional snow held on the roof will not cause structural issues. �. St 0_W T �.B �,/ _ B1, Inc. P.O. Box 211563 St. Paul, MN 55121 -1563 I 00 M N MATERIAL ❑ Copper ❑ Lead- Coated Copper ❑ Painted Aluminum Aluminum ❑ Customer Supplied NOTES: ROOKY MOUNTAiN SNOW Guimi i)S INC 2055 S. Raritan, Denver, CO 80223 rockymountainsnowguards.com =o 0 1. Snow guards are to be installed to manufacturer's specifications. 2. Contact manufacturer for selected layout. 3. For custom materials contact manufacturer. 2.38 SnowTrapper (ST9) HALF -PAD ROUND STYLE SNOW GUARD 07 52 53 Snow Guards _Viotu ROCKY MOUNTAIN SNOW GUARDS INC y_11 1. Follow recommended layout pattern for specific roof and snow situation following the Rocky Mountain Snow Guard Layout Guide. 2. There should be 2" spacing between the snow guard pad face itself and the butt of the course above. 3. Fasten snow guard with appropriate fasteners in the top 3" of strap. 4. Continue shingling the roof. Address: 2055 S. Raritan Denver, CO 80223 Toll Free: (877)414 -7606 Fax: (720)387 -8361 www.rockvmountainsnow$wards com IF73 Otm o°o C4 • � � W � C � f a, � •,.,`may„ ! ; OL Q r r r 1 cs • , a Pub uie{ry OD C4 0 a +4y a6uetp aJoIs POU x � •mot ,.,,� � ���. -- �. Zrz /f CL Ir- ry of II /C',D) .0 -R Self- Regulating Roof & Gutter • Roof and Gutter De-icing • Fast, Easy Installation • Cut to Length • UL Listed • CSA Certified • Approximate Size 3 /8 "W x 1 /8 "H • Minimum Bend Radius 1 -118" Chromalox SRF -RG self - regulating heat- ing cable provides reliable freeze protection of roofs and gutters. Because SRF -RG is self - regulating, it automatically adjusts to the appropriate heat output as ambient condi- tions change, making it both energy efficient and cost effective. The protective waterproof outer jacket is suitable for wet applications in downspouts and roof drains. Likewise, it is easy to apply SRF -RG following the provided instruction sheets and utilizing the required accessory kits. It can be cut -to- length and single overlapped. Simply trace the gutter or roof and energize the cable when precipitation is expected. From that point on, SRF -RG will rapidly increase its output when in contact with snow or ice, providing maximum melting power. When the roof and gutters are clear of snow and ice, the SRF -RG cable will regulate its output and save energy. Cut to Length In Field Applications To calculate the amount of cable needed, multiply roof edge length to be heat traced by the spacing factor. The spacing factor (feet of cable required per foot of roof edge) is determined by the roof overhang, heating width (A) and heating height (B): 2. Add the total gutter length and the total downspout length to the figure calculated in step 1 to get the total length of cable required. Roof Heating Heating Overhang Width Height Spacing (In.) A (Ft.) B (in.) Factor ®ate© mama a Self Regulating output U� S R® � FM jl► 3. Determine how many circuits are required. Divide the total length of cable by the maximum circuit length (see specifications, next page). Round that number up (for example, 2.1 to 3) to get the total number of circuits. A ground fault protection device is required by NEC to minimize the danger of fire if the heating cable is damaged or improp- erly installed. A minimum trip level of 30mA is recommended to minimize nuisance tripping. Suggested breakers with 3OmA ground fault trip levels are. • 120V Single Pole Westinghouse GFEPD, Square D Q0, EPD Style • 120/240V Single Pole Westinghouse GFEPD, Square D Q0, EPD Style. G -32 Fro, . 177 e �i 2. Add the total gutter length and the total downspout length to the figure calculated in step 1 to get the total length of cable required. Roof Heating Heating Overhang Width Height Spacing (In.) A (Ft.) B (in.) Factor ®ate© mama a Self Regulating output U� S R® � FM jl► 3. Determine how many circuits are required. Divide the total length of cable by the maximum circuit length (see specifications, next page). Round that number up (for example, 2.1 to 3) to get the total number of circuits. A ground fault protection device is required by NEC to minimize the danger of fire if the heating cable is damaged or improp- erly installed. A minimum trip level of 30mA is recommended to minimize nuisance tripping. Suggested breakers with 3OmA ground fault trip levels are. • 120V Single Pole Westinghouse GFEPD, Square D Q0, EPD Style • 120/240V Single Pole Westinghouse GFEPD, Square D Q0, EPD Style. G -32 Fro, . 177 e SRFDP_ specifccutions Maximum Circarit Length (Ft. Wt. /1000' Model Stock 1 PCN (Lbs.) Cable Buss Wire 16 AWG. Nickel- Coated Copper Sell Regulating Ground Braid Tinned Copper Braid Under Jacket Roof & Gutter contd! ) fluter Jacket UV Stabilized Weatherproof Jacket JSRF 5 -2RG Environmental Use Use only in Ordinary Areas, 150 °F Max. Exposure 64 Accessories Temperature Power termination into junction box with 1 end seal and 2 Outptd Wattage 12 W /Ft. in Snow or Ice @ 32 °F 386206 Service Voltage SRF 5 -1 RG 120 Vac "Warning-Electric Traced" adhesive labels SRF 5 -2RG 208 - 277 Vac Maximum Circarit Length (Ft. Wt. /1000' Model Stock 1 PCN (Lbs.) Cable 120V Cable with braid and weatherproof jacket SRF 5-1 RG S 386329 64 208 - 277V Cable with braid and weatherproof jacket JSRF 5 -2RG 1 S 386337 64 Accessories Power Connection Kit Power termination into junction box with 1 end seal and 2 RG -PK -1 S 386206 1 "Warning-Electric Traced" adhesive labels Splice Kit Materials for 1 splice of cable RG -SK -1 S 366214 1 End Seal Kit Materials for 1 cable end termination RG -EK -1 S 386257 1 Roof Clips To attach cable to standard roofing material, 10 per kit RCK -1 S 340179 1 Downspout Hangers To support cable in gutter downspout, 1 pack per carton RDK -1 S 340160 1 Aluminum Tape Aluminum toil installation tape with pressure sensitive adhesive, AT -1 S 383355 1 180 ft. roll. Used to secure cable placement in gutters. Note— Cables are UL Listed for Snow Melting and De -Icing Equipment. Thermostats RTAS, RTBC, B1o0, E100 (See SRL page G -10 for details) Ron, f & Gutter Accessories RG- PK- 1(386206) RG -SK -1 (3862.14) 14 W11- Pou+er Connection Kit Power termination into junction box with one end seal and two "Warn- ing- Electric Traced" labels .Splice Kit Materials to make one splice con- nection. Special weatherproof sleev- ing to insure trouble -free operation RCK— I d RI)K J 11n It" ti:pag Kits A/ RDKI Rfi -EX -1 {386257} RCK -1 (340179) Roof clips (10) to attach cable RDK -1 (340160) Downspout hangers (1) to suspend cable in downspout W Seal Kit Seals cable at end termination a� m co 4'' N s r as J co CD 0_ 1 _0 O �/� 1�� 3 N r t .l� 1 I N 419 L O. CL a1 � a y .Q m � I I -- --. Y � U CD w+ \ S € N N -- -- � y o ueya edols loo f' O o �r tn N —- XY / l N 00' 96psu uievy o D o _ m C � 770 R a N f --�`— CO I N 419 L O. CL a1 � a y .Q m � I I -- --. Y � U CD w+ \ S € N N -- -- � y o ueya edols loo f' O o �r tn N —- XY / l N 00' Load List 3 x 30 Amps Breakers 1 rer %.,ircuit Dable SRF 8 -2CR Joltage 220V 3reaker Size 30 Amps 'ower Output 7.86 W/ft Dable Length 320' Vomical Current 11.44 Amps Startup Current 23.89 Amps )esign Temp -40F Startup Temp -40F Transformer Load 3.02KW 3 x 30 Amps Breakers 1 F, • �r r - Visit our websde for more Information on Roof De- Icing Systems Roof De -Icing System • Aluminium Construction • Angled or Flat Surface Designs • Corrosion Resistant Coating Available U Mod el PLD-EC I PGN 1 Stock 1 Length 1 393967 S 4' 1 PLD -ECF 13939751 S 1 4' 1 Cover -EC 13939831 5 1 4' 1 1 ,f aesgv.; -i', yr o it http:fiwv v.chrornalox.com Edge Cutter Gutter Edge - Cutter' is an aluminum flashing de- Valleys on a roof may also be heat traced with signed to be used as a heat conductive plate to Edge -Cutter PLD -ECF (Flat Flashing). aid in keeping snow and ice from roof edges. The system is for use only with self- regulat- Edge- Cutter can be fastened using various ing heating cables certified for use in roof and methods including screws or adhesives de- gutter applications. pending on application and building materials. Edge -Cutter is designed to be applied between Edge- Cutter can be ordered with a 6 mil urethane membrane applied to help prevent galvanic oxidation or the roofing and the roof substrate. It can be corrosion when in contact with dissimilar metals. used with various roofing products such as asphalt shingles, aluminum, steel' and even slate. PLO-EC (Angled flashing) PLO-ECF (Flat flashing) Cover Edge-Cutter' Roof De -Icing System ( ont'd.) Valleys can also be heat traced using Edge - Cutter PLO -ECF flat flashing. Dual or single flashing can be used in the valleys u x;. �._ E y► Method 1 Dual Flashing Edge -Cutter flashing can be cut to fit your specific roofing layout, Screws or adhesive can be used to easily attach the Edge -Cutter system to your roof. f i 7 G d1 Woodcrest® Shingles Owens CorningTM Roofing Pagel of 4 Roofing and Asphalt Contact us ,_CargersSustainabiiity searcfi nscamFng:rorn 4 Roofing Basics Browse Shingles & Total Protection Accessories Roofing SystemT' Warranty Find a Contractor M i Qrn a Homeowner 9 95101 0 Roofing Browse Shingles Woodcrese Shingles Woodcresr""-'Y'Shingles — Rugged, Rustic Beauty � c� Thick, ruggedly beautiful Woodcresr- Shingles have a rustic, textured appearance to create the look of wood shakes. But their real appeal comes from their durability. And when used with color- matched Owens CorningTm Hip & Ridge Shingles, the architectural interest of the home is increased. • Limited Lifetime Warranty''t (for as long as you own your home) • 110 /130 - MPH * * ** Wind Resistance Limited Warranty* • Algae Resistance Limited Warranty* • Nominal weight of 345 lb. per square • Meet the highest fire resistance standards in the industry • Infused with pops of color not available on real wood Warranty Length* Limited Lifetimet (for as long as you own your home) http://www.owenscoming.com/roofing/browse-shingles/woodcrest/ 5/20/2015 ,odcrest® Shingles I Owens Corning"m Roofing Page 2 of 4 Wind Resistance 110/130 MPH * * ** Nominal Size 14 -1/4" x 40" Nominal Weight 350 lb./sq. Exposure 4" Shingles Per 15 Square Bundles Per 6 Square Coverage Per 100 sq. ft. Square Algae Resistance 10 year Add an attractive finished look to your roof with Hip & Ridge Shingles Not only do they increase the character and curb appeal of your home, but they also provide excellent protection to your roofs peak. Owens Corning TM Hip & Ridge Shingles are uniquely color matched for Woodcrestc Shingles and provide an important finishing element to your roof. * See actual warranty for complete details, limitations and requirements. * ** 110 MPH is standard with 4 -nail application. 130 MPH is applicable only 4th 6 -nail application in accordance with installation instructions. t On a Standard Product and Standard System Warranty, 40 -Year Limited Warranty on commercial projects. Warranty Technical Information cv- V- http:// www. owenscoming.com/roofingibrowse- shingles /woodcrest/ 5/20/2015 Acrest® Shingles I Owens CorningTM Roofing Page 1 of 4 Roofing and Asphalt __._ ..._... ___ .. ,.. Contact Us_ ....Careers . Sustain_abili _. seare#� o ns orr }tng ocam Q Roofing Basics Browse Shingles & Total Protection Accessories Roofing System Warranty Find a Contractor I 2 2 '9 95101 Q ka6 iownOr Roofing Browse Shingles Woodcrest® Shingles Woodcrest® Shingles - Rugged, Rustic Beauty Colors & Photos Product Details Warranty Technical Information Technical Documents Data Sheet Installation Instructions Product 3 -Part Specifications Download in Word httn • / /www.owenscorning.com/roofinp,/browse- shingles/woodcrest/ 5/20/2015 Acrest® Shingles I Owens CorningTM Roofing UL Evaluation Report LEED® Certification - Roofing Shingles MSDS Applicable standards ASTM D228 ASTM D3018 (Type 1) ASTM D3161 (Class F Wind Resistance) ASTM D3462 ASTM D7158 (Class H Wind Resistance) ASTM E108 (Class A Fire Resistance) CSA A123.5 IMES AC438# UL 790 (Class A Fire Resistance) UL ER2453 -01## Page 2 of 4 International Code Council Evaluation Services Acceptance Criteria for Alternative Asphalt Shingles. Underwriters Laboratories Evaluation Service Evaluation Report. # istered trademark of U.S. Green Building Council. #%dw QMWft"* Rao" Preferred contfe -'�)( httn• //www. owenscorning. com/roofinWbrowse- shingles /woodcrest/ 5/20/2015 t NORTH ELEVATION Parcel A (left), Parcel B (right, match this existing roof) NORTH ELEVATION Parcel A BLUMBERG RESIDENCE RE -ROOF Parcel A, 366 Forest Road, TOV DRB150040 NORTH ELEVATION Parcel B (match this existing roof) SOUTH ELEVATION Parcel B (left, match this existing roof), Parcel A (right) BLUMBERG RESIDENCE RE -ROOF Parcel A, 366 Forest Road, TOV DRB150040 SOUTH ELEVATION Parcel A SOUTH ELEVATION Parcel B (match this existing rood BLUMBERG RESIDENCE RE -ROOF Parcel A, 366 Forest Road, TOV DRB150040 �� �� Department of Community Development 75 South Frontage Road ��;�€� �� '�'����' ':' Vail, CO 81657 Tet: 970.479.2128 www.vailgov.com Development Review Coordinator TRANSM ITTAL FORM Use this form when submitting additional information for planning applications or building permits. This form is also used for requesting a revision to building permits. A two hour minimum buiiding review fee of$110 will be charged upon reissuance of the permit. ....................................................................... ...............................................................................................................................................................................................................................................'................................................ Apptication/Permit#(s) information applies ta� Attention: �Revisions U j �_' � .�_ ��R7 � �j ��J� ���I �' �Response to Correctian Letter � � �`" �attached copy of correction letter �Deferred Submittal (�O;ther . . .._ , ,__ ___.... . ....... . �Project Street Address: 3� r-� !'�-�l ��� �(Number) (street) (Suite#) ':..................................................................................................................................................................................... ' BuildinglComplex Name: > Description of TransmittaU List of Changes, Items Attached: `. .......... ........................................ ..... ................................. ' � :, ,;,.. �f Po Sti �f� ��.;c_�.� �`c�, ' ............_.._.... ...................... .. � �, � ��' �,�-���: <Appticant Information ;(architect,contractor,owner/owner's rep} `Contact Name: ����1 �� � s Address: �`C� � j-�� ��) l� �t G�� , f / €City J� � � State: �� Zip: � ! �' �' c, > J� /� <Contact Name: J"L'' "l GJ�V�1"��� , , � ; (use additional sheet if necessary) : � �j � ,...�.. _::.�_..::.;�_,�,, . �,.,._.,:,�:..._,_,._;.�.. _��_�-..�,...:'. ti �� ;Contact Phone: �-�% Z S�"�j ( � '� ,:�..��;��r: Build�ng Permits: ��,.,� /�`� ����� �v``'� 'Revised ADDITIONAL Valuations (Labor& Materials) �Cantact E-Maii: ; (D�NOT include original vatuation) ; I hereby acknowledge that I have read this application,filled out 'guiiding: $ ; in full the information required,completed an accurate plot plan, f: and state that all the'snformation as required is correct. I agree to 'Ptumbing: $ comp(y with the information and plot plan, to comply with a{I Town < � ordinances and state laws, and to build this structure according 'Electricaf: $ ! to the town's zoning and subdivision codes, design review ap- ; proved, Internatianal Building and Residenfial Codes and other ;:Mechanicaf: $ ; ordinances of the Tow�p licable thereta. �X �� �_ �Total: $� : __ : ;Owner/Owner's Representative Signature(Required) ' ° .....................................................................................................................................................................................; : ............................................................................. � .............................._._........................................................................ Date Receiv - (sC� [� � M � �1 � �� For Office ifse Onlc: ��� ��" � ���� I% Fee Paid: �- b Received From: � �1 r� ' Cash Check# _ TvW� t✓�. ����.- _� CC: Visa/MC Last 4 CC# exp.date: Authorization#